System and method providing directional ultrasound therapy to skeletal joints

• US 20060241576A1
• Filed: 02/27/2006
• Published: 10/26/2006
• Est. Priority Date: 01/15/2002
• Status: Abandoned Application

• Current Assignee: Regents of the University of California (University of California)
• Original Assignee: Regents of the University of California (University of California)
• Inventors: Bradford, David S., Lotz, Jeffrey C., Nau, Will, Diederich, Chris J.
• Application Number:
  US11/364,357
• Publication Number:
  US 20060241576A1
• Time in Patent Office: Days
• US Class Current: 606/27
• CPC Class Codes: A61B 18/04 by heating by applying electromagnetic radiation A61B18/18; hyperthermia using electric or magnetic fields, radiation or ultrasound A61N
• CPC Class Codes: A61B 2017/00092 using thermocouples
• CPC Class Codes: A61B 2017/00101 using an array of thermosensors
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2090/374 NMR or MRI
• CPC Class Codes: A61N 2007/0021 Neural system treatment
• CPC Class Codes: A61N 2007/003 Destruction of nerve tissue
• CPC Class Codes: A61N 2007/0056 Beam shaping elements
• CPC Class Codes: A61N 2007/0078 with multiple treatment transducers
• CPC Class Codes: A61N 7/02 Localised ultrasound hyperthermia hyperthermia in general A61F7/00
• CPC Class Codes: A61N 7/022 intracavitary

Abstract

An ultrasound therapy system and method is provided that provides directional, focused ultrasound to localized regions of tissue within body joints, such as spinal joints. An ultrasound emitter or transducer is delivered to a location within the body associated with the joint and heats the target region of tissue associated with the joint from the location. Such locations for ultrasound transducer placement may include for example in or around the intervertebral discs, or the bony structures such as vertebral bodies or posterior vertebral elements such as facet joints. Various modes of operation provide for selective, controlled heating at different temperature ranges to provide different intended results in the target tissue, which ranges are significantly affected by pre-stressed tissues such as in-vivo intervertebral discs. In particular, treatments above 70 degrees C., and in particular 75 degrees C., are used for structural remodeling, whereas lower temperatures achieve other responses without appreciable remodeling.

Claims

1. An ultrasound energy delivery system for treating a region of tissue associated with a skeletal joint, comprising:

an ultrasound treatment assembly with an ultrasound transducer;

a skeletal joint delivery assembly that is adapted to deliver the ultrasound treatment assembly into the body with the ultrasound transducer positioned at a location within the body associated with the skeletal joint; and

wherein the ultrasound treatment assembly is adapted to deliver a therapeutic level of ultrasound energy from the location and into the region of tissue.

2. The system of claim 1, wherein the skeletal joint delivery assembly comprises a needle.

3. The system of claim 1, wherein the skeletal joint delivery assembly comprises a cannula with a sharpened tip that is adapted to puncture a tissue barrier associated with the joint.

4. The system of claim 1, wherein:

the skeletal joint delivery assembly comprises a guidewire; and

the ultrasound treatment assembly is adapted to be delivered over the guidewire to the location.

5. The system of claim 1, wherein:

the skeletal joint delivery assembly comprises a cannula; and

the ultrasound treatment assembly is adapted to be delivered through the cannula to the location.

6. The system of claim 1, wherein the ultrasound treatment assembly is adapted to be steerable to the location.

7. The system of claim 6, wherein the ultrasound treatment assembly is located on a deflectable member.

8. The system of claim 1, wherein the ultrasound treatment assembly is located on a pre-shaped support member.

9. The system of claim 1, wherein the ultrasound transducer is constructed to provide directional thermal therapy to the region of tissue.

10. The system of claim 9, wherein the ultrasound transducer is constructed to deliver a converging field of energy to the region of tissue.

11. The system of claim 9, wherein the ultrasound transducer is constructed to deliver a diverging field of ultrasound energy to the region of tissue.

12. The system of claim 9, wherein the ultrasound transducer is constructed to deliver a substantially collimated field of ultrasound energy to the region of tissue.

13. The system of claim 1, wherein the ultrasound treatment assembly comprises a coupling member positioned so as to couple ultrasound energy from the ultrasound transducer to the region of tissue.

14. The system of claim 13, wherein:

the coupling member comprises a radially extendable member that is adapted to radially extend from a first contracted position relative to the ultrasound transducer to a second extended position relative to the ultrasound transducer that is further away from the ultrasound transducer than the first position; and

the ultrasound transducer is adapted to delivery the ultrasound energy to the region of tissue via the coupling member with the radially extendable member in the second extended position.

15. The system of claim 14, wherein:

the extendable member comprises an inflatable balloon that is adapted to be coupled to a source of inflation medium and to inflate with a pressurized volume of fluid from the source; and

the ultrasound transducer is adapted to deliver the ultrasound energy to the tissue via the fluid and inflatable balloon.

16. The system of claim 1, further comprising:

a temperature control system that is adapted to control the temperature of at least one of the ultrasound transducer or a tissue interface between a region of tissue and the ultrasound treatment assembly during ultrasound energy delivery to the region of tissue.

17. The system of claim 16, wherein the ultrasound treatment assembly is adapted to actively cool the ultrasound transducer or tissue interface.

18. The system of claim 1, further comprising:

a cooling system with a controller;

wherein the ultrasound treatment device is adapted to couple to the cooling system; and

wherein the cooling system via the controller is adapted to cool at least one of the ultrasound transducer and a region of tissue being affected by the ultrasound delivery.

19. The system of claim 18, wherein the cooling system is adapted to cool the ultrasound transducer with a fluid having a temperature less than room temperature.

20. The system of claim 18, wherein the fluid temperature is about zero degrees C.

21. The system of claim 18, wherein the fluid temperature is equal to or greater than about room temperature.

22. The system of claim 18, wherein the cooling system comprises:

a source of fluid medium; and

wherein the cooling system is adapted to circulate fluid from the source through the ultrasound treatment device so as to cool the ultrasound transducer.

23. The system of claim 1, further comprising:

an ultrasound control system with a temperature monitoring system, a controller, and an ultrasound drive system;

wherein the ultrasound treatment assembly is adapted to couple to the ultrasound control system; and

wherein the ultrasound control system is adapted to control the ultrasound energy being emitted by the ultrasound transducer as a function of at least one parameter related to thermal therapy in the region of tissue.

24. The system of claim 23, wherein the at least one parameter comprises a parameter related to the operation of the ultrasound transducer.

25. The system of claim 24, wherein the at least one parameter comprises impedance, voltage, current, power, temperature, reflected power, or rates of change thereof.

26. The system of claim 23, wherein the at least one parameter comprises a parameter related to the effects of ultrasound delivery from the ultrasound transducer in tissue.

27. The system of claim 26, wherein the ultrasound control system is adapted to control operation of the ultrasound delivery assembly based upon a temperature monitored at a coupling tissue surface between the tissue and the ultrasound delivery assembly.

28. The system of claim 26, wherein the at least one parameter comprises thermal dose, tissue temperature, depth of thermal penetration, or rates of change thereof.

29. The system of claim 23, wherein the at least parameter is empirically based.

30. The system of claim 23, wherein the at least one parameter comprises a value that is monitored during ultrasound therapy.

31. The system of claim 23, wherein the at least one parameter comprises a value that is calculated based upon another measured parameter.

32. The system of claim 23, wherein the controller is adapted to control the operation of the ultrasound transducer such that the temperature in at least a portion of the tissue within at least a 4 mm depth from the ultrasound transducer is elevated to at least about 70 degrees C. in response to ultrasound energy being delivered thereto from the ultrasound transducer.

33. The system of claim 32, wherein the controller is adapted to control the operation of the ultrasound transducer such that the temperature of the tissue within the 4 mm depth is elevated to at least about 75 degrees C. in response to the ultrasound energy delivery.

34. The system of claim 23, wherein the controller is adapted to control the operation of the ultrasound transducer such that the temperature in tissue within up to at least about a 7 mm depth from the ultrasound transducer is elevated to at least about 70 degrees C.

35. The system of claim 23, wherein the controller is adapted to control the operation of the ultrasound transducer such that the temperature in tissue within up to at least a 10 mm depth from the ultrasound transducer is elevated to greater than about 45 degrees C.

36. The system of claim 23, wherein the controller is adapted to control the operation of the ultrasound transducer such that the temperature within the tissue at up to at least a 4 mm depth from the ultrasound transducer is elevated to an elevated temperature of no more than about 75 degrees C. or less.

37. The system of claim 36, wherein the controller is adapted to control the operation of the ultrasound transducer such that the temperature of the tissue within the 4 mm depth is elevated to an elevated temperature of no more than about 70 degrees C. or less.

38. The system of claim 23, wherein the controller is adapted to control the operation of the ultrasound transducer such that the temperature in tissue within up to at least a 7 mm depth from the ultrasound transducer is elevated to at least 70 degrees C.

39. The system of claim 23, wherein the controller is adapted to control the operation of the ultrasound transducer such that the temperature in tissue within up to at least a 10 mm depth from the ultrasound transducer is elevated to greater than 45 degrees C.

40. The system of claim 1, wherein the ultrasound treatment assembly is adapted to heat tissue up to a distance of at least about 4 mm from the ultrasound transducer to a temperature of at least about 70 degrees C.

41. The system of claim 40, wherein the ultrasound heating assembly is adapted to heat the tissue within the 4 mm depth to a temperature of at least about 75 degrees C.

42. The system of claim 41, wherein the ultrasound treatment assembly is adapted to heat the tissue at least about 4 mm away from the transducer to the temperature of at least about 75 degrees C. in less than about 5 minutes of ultrasound energy delivery into the tissue.

43. The system of claim 1, wherein the ultrasound treatment assembly is adapted to heat tissue up to a distance of at least about 7 mm from the ultrasound transducer to a temperature of at least about 70 degrees C.

44. The system of claim 1, wherein the ultrasound treatment assembly is adapted to heat tissue up to a distance of at least about 10 mm from the ultrasound transducer to a temperature of at least about 45 degrees C.

45. The system of claim 1, wherein the ultrasound treatment assembly is adapted to heat tissue up to a distance of at least 4 mm from the ultrasound transducer to a temperature of no more than about 75 degrees C. or less.

46. The system of claim 1, wherein the ultrasound treatment assembly is adapted to be positioned within an intervertebral disc and to heat at least portion of the disc.

47. The system of claim 1, wherein the ultrasound treatment assembly is adapted to be positioned at a location adjacent to an intervertebral disc and to provide thermal therapy to the intervertebral disc from that location.

48. The system of claim 1, wherein the ultrasound treatment assembly is adapted to be positioned within at least a portion of a vertebral body and to provide thermal therapy at least in part to the vertebral body.

49. The system of claim 1, wherein the ultrasound treatment assembly is adapted to be positioned at a location adjacent to a vertebral body and to heat at least a portion of the vertebral body.

50. The system of claim 1, wherein the ultrasound treatment assembly and the skeletal joint delivery assembly are integrated.

51. The system of claim 50, wherein:

the skeletal joint delivery assembly comprises a substantially rigid probe device with a proximal end portion and a distal end portion; and

the ultrasound heating assembly is located along the distal end portion.

52. The system of claim 1, wherein the ultrasound treatment assembly and skeletal joint delivery assembly are separate devices that cooperate together.

53. The system of claim 1, wherein the skeletal joint delivery assembly comprises a spinal joint delivery assembly.

54. The system of claim 1, wherein the ultrasound treatment assembly and spinal joint delivery assembly together comprise an external directional ultrasound thermal therapy system.

55. The system of claim 1, wherein the ultrasound treatment assembly and spinal joint delivery assembly together comprise an internal directional ultrasound thermal therapy system.

56. The system of claim 1, wherein the ultrasound treatment assembly comprises a single curvilinear ultrasound transducer.

57. The system of claim 1, wherein the ultrasound treatment assembly comprises multiple curvilinear ultrasound transducers.

58. The system of claim 1, wherein the ultrasound transducer is adapted to emit directed, therapeutic ultrasound energy within a treatment zone of less than or equal to about one hundred eighty degrees relative to the ultrasound transducer.

59. The system of claim 58, wherein the treatment zone is less than or equal to about ninety degrees.

60. The system of claim 1, wherein the ultrasound transducer is comprises a curved shape with a radius of curvature that is around a reference axis that is transverse to the longitudinal axis of a support member upon which the ultrasound transducer is mounted.

61. The system of claim 1, wherein the ultrasound transducer is comprises a curved shape with a radius of curvature that is around a reference axis that is aligned with the longitudinal axis of a support member upon which the ultrasound transducer is mounted.

62. A skeletal joint thermal therapy device, comprising:

a delivery member with a proximal end and a distal end portion;

a thermal treatment assembly with an energy emitter on the distal end portion;

wherein the distal end portion is adapted at least in part to deliver the thermal treatment assembly into a body of a mammal with the energy emitter positioned at a location such that the energy emitter is adapted to deliver energy into a region of tissue associated with a skeletal joint; and

wherein the thermal treatment assembly is adapted to heat tissue up to a distance of at least 4 mm from the energy emitter to a temperature of at least 75 degrees C., and is adapted to heat tissue up to a distance of at least about 7 mm from the energy emitter to a temperature of at least about 55 degrees C., and is adapted to heat tissue up to a distance of at least about 10 mm from the energy emitter to a temperature of at least about 45 degrees C.

63. The device of claim 62, wherein the thermal treatment assembly is adapted to heat tissue up to a distance of at least 4 mm from the energy emitter to a temperature of at least 80 degrees C.

64. The device of claim 62, wherein the thermal treatment assembly is adapted to heat tissue up to a distance of at least 4 mm from the energy emitter to a temperature of at least 85 degrees C.

65. The device of claim 62, wherein the thermal treatment assembly is adapted to heat tissue up to a distance of at least 7 mm from the energy emitter to a temperature of at least 60 degrees C.

66. The device of claim 62, wherein the thermal treatment assembly is adapted to heat tissue up to a distance of at least 7 mm from the energy emitter to a temperature of at least 65 degrees C.

67. The device of claim 62, wherein the thermal treatment assembly is adapted to heat tissue up to a distance of at least 7 mm from the energy emitter to a temperature of at least 70 degrees C.

68. The device of claim 62, wherein the thermal treatment assembly is adapted to heat tissue up to a distance of at least 10 mm from the energy emitter to a temperature of at least 50 degrees C.

69. The device of claim 62, wherein the thermal treatment assembly is adapted to heat tissue up to a distance of at least 10 mm from the energy emitter to a temperature of at least 55 degrees C.

70. The device of claim 62, wherein the thermal treatment assembly is adapted to heat tissue up to a distance of at least 10 mm from the energy emitter to a temperature of at least 60 degrees C.

71. The system of claim 62, wherein the thermal treatment assembly is constructed to provide directional thermal therapy to the region of tissue.

72. The system of claim 62, wherein the thermal treatment assembly is constructed to deliver a converging field of energy to the region of tissue.

73. The system of claim 62, wherein the thermal treatment assembly is constructed to deliver a diverging field of energy to the region of tissue.

74. The system of claim 62, wherein the thermal treatment assembly is constructed to deliver a substantially collimated field of energy to the region of tissue.

75. The system of claim 62, wherein the energy emitter comprises an ultrasound transducer.

76. The system of claim 62, wherein the ultrasound treatment assembly comprises a coupling member positioned so as to couple ultrasound energy from the ultrasound transducer to the region of tissue.

77. An ultrasound thermal treatment system, comprising:

an ultrasound treatment assembly with an ultrasound transducer;

a rigid delivery probe having a elongate body with a proximal end portion and a distal end portion;

the distal end portion has a proximal section with a longitudinal axis, a distal section with a distal tip, and a bend between the proximal and distal sections;

wherein the ultrasound treatment assembly is located along the distal section of the distal end portion and extending at an angle from the proximal section;

wherein the distal end portion is adapted to be delivered into the body of a mammal by manipulating the proximal end portion externally of the body and such that the ultrasound treatment assembly is positioned at a location associated with a region of tissue to be treated; and

wherein the ultrasound treatment assembly is adapted to deliver a therapeutic level of ultrasound energy into the region of tissue from the location within the body.

78. The system of claim 77, wherein the proximal end portion of the rigid delivery probe comprises a metal tube.

79. The system of claim 77, wherein the distal end portion of the rigid delivery probe comprises a metal tube.

80. The system of claim 77, wherein the ultrasound transducer is constructed to provide directional ultrasound delivery to the region of tissue.

81. The system of claim 77, wherein the ultrasound transducer is constructed to deliver a converging field of ultrasound energy to the region of tissue.

82. The system of claim 77, wherein the ultrasound transducer is constructed to deliver a diverging field of ultrasound energy to the region of tissue.

83. The system of claim 77, wherein the ultrasound transducer is constructed to deliver a substantially collimated field of ultrasound energy to the region of tissue.

84. The system of claim 77, wherein the ultrasound treatment assembly comprises a coupling member positioned so as to couple ultrasound energy from the ultrasound transducer to the region of tissue.

85. The system of claim 77, further comprising a temperature control system coupled to the ultrasound treatment assembly.

86. The system of claim 77, further comprising a drug delivery system that is adapted to deliver a drug into the region of tissue when the ultrasound treatment assembly is delivering the therapeutic ultrasound to the region of tissue.

87. An ultrasound thermal therapy system, comprising:

an ultrasound heating assembly with an ultrasound transducer;

a therapy control system coupled to the ultrasound heating assembly;

wherein the ultrasound heating assembly is adapted to be delivered into a body of a mammal with the ultrasound transducer positioned at a location such that the ultrasound transducer is adapted to deliver a therapeutic amount of ultrasound energy into a targeted region of tissue in the body from the location; and

wherein the therapy control system is adapted to control operation of the ultrasound heating assembly such that a substantial portion of the region of tissue being heated by the ultrasound heating assembly does not exceed a maximum temperature of at least about 70 degrees C.

88. The system of claim 87, wherein the therapy control system is adapted to control operation of the ultrasound heating assembly such that a substantial portion of the region of tissue being heated by the ultrasound heating assembly does not exceed a maximum temperature of at least about 75 degrees C.

89. A directional ultrasound spinal thermal therapy system, comprising:

an ultrasound delivery assembly with a directional ultrasound transducer that is adapted to be positioned at a location associated with a spinal joint and to deliver a directed, therapeutic amount of ultrasound energy from the location and to a region of tissue associated with the spinal joint.

90. The system of claim 89, further comprising:

a support member comprising an elongate body with a proximal end portion and a distal end portion;

wherein the ultrasound delivery assembly is located along the distal end portion.

91. The system of claim 90, wherein the ultrasound delivery assembly is adapted to direct the ultrasound delivery into substantially only a particular radial zone around the circumference of the distal end portion of the support member.

92. The system of claim 89, wherein the ultrasound delivery assembly is constructed to provide directional thermal therapy to the region of tissue.

93. The system of claim 89, wherein the ultrasound delivery assembly is constructed to deliver a converging field of energy to the region of tissue.

94. The system of claim 89, wherein the ultrasound delivery assembly is constructed to deliver a diverging field of energy to the region of tissue.

95. The system of claim 89, wherein the ultrasound delivery assembly is constructed to deliver a substantially collimated field of energy to the region of tissue.

96. The system of claim 89, wherein the ultrasound treatment assembly comprises a coupling member positioned so as to couple ultrasound energy from the ultrasound transducer to the region of tissue.

97. The system of claim 89, wherein the ultrasound delivery assembly is adapted to be positioned at the location within at least a portion of an intervertebral disc associated with the spinal joint and to deliver the therapeutic ultrasound energy into the region of tissue from that location.

98. The system of claim 89, wherein the ultrasound delivery assembly is adapted to be positioned at the location outside of an intervertebral disc associated with the spinal joint and to deliver the therapeutic level of ultrasound energy into the intervertebral disc from that location.

99. The system of claim 89, wherein the ultrasound delivery assembly is adapted to be positioned at the location within at least a portion of a vertebral body associated with the spinal joint and to be ultrasonically coupled with the region of tissue from that location.

100. The system of claim 89, wherein the ultrasound delivery assembly is adapted to be positioned at the location outside of a vertebral body associated with the spinal joint and to deliver the therapeutic level of ultrasound energy into the intervertebral disc from that location.

101. A skeletal joint ultrasound delivery system, comprising:

an ultrasound treatment assembly with an ultrasound transducer and a coupling member;

wherein the ultrasound delivery assembly is adapted to be delivered into a body of a mammal with the ultrasound transducer positioned at a location within the body associated with a skeletal joint; and

wherein the ultrasound transducer is adapted to deliver a therapeutic amount of ultrasound energy to a region of tissue associated with the skeletal joint via the coupling member.

102. The system of claim 101, wherein the ultrasound delivery assembly is constructed to provide directional ultrasound delivery to the region of tissue.

103. The system of claim 101, wherein the ultrasound delivery assembly is constructed to deliver a converging field of energy to the region of tissue.

104. The system of claim 101, wherein the ultrasound delivery assembly is constructed to deliver a diverging field of energy to the region of tissue.

105. The system of claim 101, wherein the ultrasound delivery assembly is constructed to deliver a substantially collimated field of energy to the region of tissue.

106. The system of claim 101, wherein the ultrasound treatment assembly comprises a coupling member positioned so as to couple ultrasound energy from the ultrasound transducer to the region of tissue.

107. The system of claim 106, wherein:

the coupling member comprises a radially extendable member that is adapted to radially extend from a first contracted position relative to the ultrasound transducer to a second extended position relative to the ultrasound transducer that is further away from the ultrasound transducer than the first position; and

the ultrasound transducer is adapted to delivery the ultrasound energy to the region of tissue via the coupling member with the radially extendable member in the second extended position.

108. The system of claim 107, wherein:

the extendable member comprises an inflatable balloon that is adapted to be coupled to a source of inflation medium and to inflate with a pressurized volume of fluid from the source; and

the ultrasound transducer is adapted to deliver the ultrasound energy to the tissue via the fluid and inflatable balloon.

109. The system of claim 108, wherein the inflatable balloon is substantially non-compliant and preformed.

110. The system of claim 108, wherein the inflatable balloon comprises a substantially compliant, elastomeric balloon material.

111. The system of claim 101, wherein the ultrasound delivery assembly is adapted to be positioned at the location within at least a portion of an intervertebral disc associated with the spinal joint and to deliver the therapeutic ultrasound energy into the region of tissue from that location.

112. The system of claim 101, wherein the ultrasound delivery assembly is adapted to be positioned at the location outside of an intervertebral disc associated with the spinal joint and to deliver the therapeutic level of ultrasound energy into the intervertebral disc from that location.

113. The system of claim 101, wherein the ultrasound delivery assembly is adapted to be positioned at the location within at least a portion of a vertebral body associated with the spinal joint and to be ultrasonically with the region of tissue from that location.

114. The system of claim 101, wherein the ultrasound delivery assembly is adapted to be positioned at the location outside of a vertebral body associated with the spinal joint and to deliver the therapeutic level of ultrasound energy into the intervertebral disc from that location.

115. An ultrasound thermal therapy system, comprising:

an ultrasound heating assembly that is adapted to be positioned at a location within a body of a mammal so as to deliver ultrasound energy into a region of tissue in the body from the location; and

a control system coupled to the ultrasound heating assembly and adapted to control operation of the ultrasound heating assembly such that a region of tissue being heated by the ultrasound heating assembly exceeds a temperature of at least about 70 degrees C.

116. An ultrasound thermal therapy system, comprising:

a delivery member with a proximal end portion and a distal end portion with a longitudinal axis;

an ultrasound heating assembly located along the distal end portion of the delivery member and with a curvilinear ultrasound transducer having a concave surface with a radius of curvature around a reference axis that is transverse to the longitudinal axis of the distal end portion.

117. A method for invasively treating a medical condition associated with a skeletal joint within a body of a patient, comprising:

delivering a therapeutic level of ultrasound energy to a region of tissue associated with the joint from a location within the body of the patient.

118. A method for treating a medical condition associated with a skeletal joint within a body of a patient, comprising:

delivering sufficient energy to a region of tissue associated with the skeletal joint that is sufficient to necrose nociceptive nerve fibers or inflammatory cells in such tissue region without substantially affecting collagenous structures associated with the skeletal joint.

119. The method of claim 118, further comprising:

delivering the energy into the region of tissue while the region of tissue is under mechanical stress; and

heating the tissue to a temperature of up to no more than 75 degrees C.

120. The method of claim 119, further comprising:

heating the tissue to a temperature of up to no more than 70 degrees C.

121. A method for treating a region of tissue associated with an intervertebral disc in a body of a patient, comprising:

delivering an ultrasound transducer to a location within the body such that a therapeutic level of ultrasound may be coupled from the transducer to the tissue.

122. A method for treating a patient, comprising:

delivering energy to a region of tissue associated with the spine, wherein such tissue does not experience a rise in temperature of more than about 55 degrees C.

123. A method for treating a patient, comprising:

delivering energy to a region of tissue associated with the spine, wherein such energy delivery is between about 10 and about 300 equivalent minutes at 43 degrees C.

124. A method for invasively treating a medical condition associated with an intervertebral disc within a body of a patient, comprising:

delivering a therapeutic level of ultrasound energy to a region of tissue associated with an intervertebral disc from a location within the body of the patient.

125. A method for treating medical condition associated with a joint between two bony structures in a body of a patient, comprising:

delivering an ultrasound transducer to a location within the patient'"'"'s body associated with the joint;

emitting ultrasound energy from the transducer at the location so as to provide a therapeutic effect to at least a portion of the joint.

126. The method of claim 125, further comprising:

focusing the ultrasound energy from the transducer toward the portion.

127. The method of claim 125, wherein the location is within the joint between the two bony structures.

128. The method of claim 125, wherein the joint is between two vertebral bodies in a spine of the patient.

129. The method of claim 125, wherein the portion heated comprises at least a portion of an intervertebral disc.

130. The method of claim 125, wherein the portion heated comprises at least a portion of an annulus fibrosus of the intervertebral disc.

131. The method of claim 125, further wherein the location is at least in part within an annulus fibrosus of the intervertebral disc.

132. The method of claim 125, wherein the location is adjacent to and outside of an annulus fibrosus of the intervertebral disc.

133. The method of claim 125, wherein the location is adjacent to a vertebral body associated with the spinal joint.

134. The method of claim 125, wherein the location is within a vertebral body associated with the spinal joint.

135. A method for treating a patient, comprising:

introducing an ultrasound transducer into a body of a patient;

positioning the ultrasound transducer at a location within the patient that is adjacent to at least one of an annulus fibrosus of an intervertebral disc, a nucleus pulposus of the intervertebral disc, or a vertebral body associated with a spinal joint in the body; and

emitting ultrasound energy from the ultrasound transducer at the location.

136. A method for providing ultrasound energy delivery within a body of an animal, comprising:

introducing an ultrasound transducer into a body of a patient;

positioning the ultrasound transducer at a location within the patient that is within at least one of an annulus fibrosus of an intervertebral disc, a nucleus pulposus of the intervertebral disc, or a vertebral body associated with a spinal joint in the body; and

emitting ultrasound energy from the ultrasound transducer at the location.

137. A method for treating a patient, comprising:

ultrasonically heating a region of tissue associated a spinal joint to a temperature between about 45 to about 90 degrees C. for sufficient time to cause a therapeutic result in the tissue.

138. The method of claim 137, further comprising heating the region of tissue to a temperature that is between about 45 to about 50 degrees.

139. The method of claim 137, further comprising providing a thermal dose to the tissue between about 10 and about 300 equivalent minutes at 43 degrees C.

140. The method of claim 137, further comprising providing sufficient thermal dose so as to cause necrosis effect in nociceptive nerve fibers or inflammatory cells in the region of tissue.

141. The method of claim 137, further comprising ultrasonically heating the region to a temperature between about 50 and about 60 degrees C.

142. The method of claim 137, further comprising providing sufficient thermal dose at appropriate temperature so as to stimulate cellular metabolism without substantially killing cells in the region of tissue.

143. The method of claim 137, further comprising heating the region sufficient to cause cellular necrosis in the tissue.

144. The method of claim 137, further comprising delivering sufficient thermal dosing to the region of tissue to cause a substantially non-necrotic cellular effect.

145. The method of claim 137, further comprising delivering sufficient thermal dosing to the region of tissue to cause preferential regeneration.

146. The method of claim 137, further comprising delivering sufficient thermal dose to the region of tissue to cause inhibition of inflammatory factors or cytokines.

147. The method of claim 137, further comprising delivering sufficient thermal dose to the region of tissue to cause modification of a healing response to injury in the region of tissue.

148. The method of claim 137, further comprising heating the region from within an annulus fibrosus of an intervertebral disc.

149. The method of claim 137, wherein the region comprises a portion of an intervertebral disc.

150. The method of claim 137, wherein the region comprises a portion of an annulus fibrosus.